الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit. The distribution of acne corresponds to the highest density of pilosebaceous units (face, neck, upper chest, shoulders and back).
Acne pathophysiology includes hyperseborrhoea, abnormal follicular keratinization and P. acnes proliferation in the pilosebaceous unit involving the sebaceous gland. Its clinical features of acne include; seborrhea, non-inflammatory lesions (open and closed comedones), inflammatory lesions (papules and pustules), nodules and cysts comprise severe nodulocystic acne and various degrees of scarring.
Persistent acne is a continuation or relapse of acne into adulthood and middle age. Adult acne is a chronic condition associated with considerable adverse psychosocial impact, but it is underestimated in many cases. Acne has significant impact on QoL. Adult acne appears to affect the QoL more than in their younger/adolescent counterparts.
Hormonal dysfunction, genetics, cosmetics use, diet, smoking, and stress are implicated as a trigger in adult female acne. The role of androgens in adult female acne is tenuous, clinical signs of HA like hirsutism, androgenetic alopecia, irregular menses and seborrhea are routinely reported across studies even though corroborative biochemical hyperandrogenemia is not consistently seen. Of the various androgenic triggers, including ovarian or adrenal and PCOS.
The aim of this study was to compare the clinical features of HA and hormonal profiles of the two acne subtypes and to evaluate the likely source of androgen excess – ovarian or adrenal – in these subtypes.
This study was conducted on 64 adult female patients who were suffering from AV and divided into two equal groups (32 patients with late-onset acne and 32 with persistent acne). They were selected from Dermatology, Andrology and STIs Department, Menoufia University Hospital.
Results of the present study showed that:
Persistent acne group was significantly younger than the late onset acne group, with a significantly earlier acne onset. Both groups had comparable predilection site, GAGS, past history of adolescent acne, family history and role of diet. No statistically significant difference was detected between both groups regarding the prevalence of clinical HA (68.8% in persistent acne group vs 53.1% in late-onset acne group) as the odds were comparable (OR in persistent acne group compared to late onset acne group was 1.941, 95% CI: 0.7 to 5.385). In comparison to late onset acne group, the persistent acne group elicited significantly lower rate of papule. On the contrary, the persistent acne group had significantly higher prevalence of hyper seborrhea and PCOS as compared to the late onset group. No statistically significant difference was noted between both groups regarding the prevalence of hirsutism, androgenetic alopecia, premenstrual flare and menstrual irregularity. Hormonal profile of both groups revealed a statistically significant difference as patients with persistent acne had significantly higher levels of TT, DHEAS, LH, LH/FSH and FAI, but lower FSH when compared to those with late onset acne. In patients with late onset acne, PCOs was significantly associated with higher rates of hirsutism, hyper seborrhea, premenstrual flare, and menstrual irregularity as all patients with PCOs complained of the previous signs. On the other hand, there was no significant difference between patients with and without PCOs as regards the prevalence of papule and androgenetic alopecia. In patients with persistent acne, PCOS was significantly associated with higher rates of papule, hirsutism, androgenetic alopecia, hyper seborrhea, premenstrual flare and menstrual irregularity.